|
AERO DV TRACHBRONCH STENT 12*2
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AERO DV TRACHBRONCH STENT 12*3
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AERO DV TRACHBRONCH STENT 12*3
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AERO DV TRACHBRONCH STENT 14*3
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO DV TRACHBRONCH STENT 14*3
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
AERO DV TRACHBRONCH STENT 18*4
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AERO DV TRACHBRONCH STENT 18*4
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AERO DV TRACHBRONCH STNT 14*20
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AERO DV TRACHBRONCH STNT 14*20
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
AEROMINI TRACHBRNCH STENT 8*15
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRACHBRNCH STENT 8*15
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRACHOBRONCH STENT 6*
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRACHOBRONCH STENT 6*
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRACHOBRONCH STENT 8*
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRACHOBRONCH STENT 8*
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 10*10
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRCHOBRNC STENT 10*10
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRCHOBRNC STENT 10*15
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 10*15
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 12*10
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRCHOBRNC STENT 12*10
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRCHOBRNC STENT 12*15
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 12*15
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
AEROMINI TRCHOBRNC STENT 14*10
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
AEROMINI TRCHOBRNC STENT 14*10
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
